News (Updated April 19,
2003)
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Thu Apr 17, 5:06 PM ET |
NEW YORK (Reuters Health) - Federal health officials at the U.S. Centers for Disease Control and Prevention (CDC) announced on Thursday an initiative designed to refocus their HIV prevention efforts.
"An estimated 200,000 people in the United States do not know they are infected with HIV and, tragically, are not getting appropriate treatment. This is an intolerable situation," CDC director Dr. Julie Gerberding told reporters.
"Our prevention efforts have stalled -- we are not making the kinds of ongoing progress that you would expect given the recent advances in HIV testing," she said.
The new initiative takes advantage of the Food and Drug Administration-licensed rapid HIV test that can easily be performed at sexually transmitted disease clinics, shelters, drug treatment centers and correctional facilities.
The fact that results are available in roughly 20 minutes, Gerberding said, means patients don't have to come in for a follow-up visit to get the test result.
The rapid HIV test provides a way to "speed up access to the test but, more importantly, speed up access to the result. But that will only be useful if then the infected people are referred or linked to the appropriate medical follow-up services," Gerberding said.
Importantly, she announced that CDC guidelines would no longer include a requirement that calls for extensive counseling as a prerequisite for getting the HIV test.
"Behavioral counseling is still critically important," Gerberding said, "but in the medical environment, this has been a barrier to getting the test done because many clinicians don't know how to do that kind of counseling or simply do not have the time. So we are removing that requirement as a condition for testing."
As part of the initiative, the CDC will work with doctors to make HIV testing a routine component of medical care. This means getting physicians to ask "simple questions about injection drug use and unsafe sex, and offer the HIV test," Gerberding said.
The CDC also wants to encourage HIV testing for pregnant women. Treating an HIV-infected pregnant women can dramatically cut the risk that her baby will become infected either before, during or after birth.
"We believe very strongly that a case of perinatal transmission really represents a failure of our public health system, and we want all mothers tested for HIV infection," Gerberding said.
The CDC is recommending the opt-out approach, in which all pregnant women who have not been tested for HIV are offered the test.
The goal is to make HIV testing a "routine part of perinatal care," Gerberding said, adding that "we are going to do everything we can to ensure that children born to infected mothers have access to antiretroviral therapy."
Gerberding emphasized that the CDC is not recommending mandatory HIV testing of any group of people, under any circumstances. "We are simply treating an HIV test like any other test that would be a normal part of routine care," she said.
As part of the initiative, the CDC will also put more focus on the HIV-infected population. In the past, most of the prevention efforts were aimed at behavior of uninfected people that put them at risk for exposure.
"That needs to continue," Gerberding said, "but we haven't put as much emphasis on HIV-infected people as a component of our prevention paradigm as perhaps we should," she said.
It's "very important" to make sure partners of HIV-infected patients have access to testing, she noted.
The CDC outlines the HIV prevention initiative in the April 18th issue of the Morbidity and Mortality Weekly Report.
SOURCE: Morbidity and Mortality Weekly Report 2003;52:330-332.
U.S. Recommends AIDS Tests for Additional Groups
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Thu Apr 17, 4:16 PM ET
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By Paul Simao
ATLANTA (Reuters) - Troubled by signs that
the battle against AIDS has stalled in the United States, federal health
officials on Thursday recommended that pregnant women, intravenous drug
users and anyone who engaged in unsafe sex be routinely screened for the
disease.
Infants born to mothers who have not been tested for the human
immunodeficiency virus which causes AIDS should also be checked, according
to new guidelines announced by the Centers for Disease Control and
Prevention.
The voluntary measures could dramatically expand the number of Americans
who are asked to take an HIV test and make the procedure much more
commonplace in doctors' offices and other primary care facilities throughout
the nation.
Routine AIDS screening had previously only been recommended for those
visiting acute care hospitals with a high incidence of HIV cases and for
patients in clinics that specialized in treating sexually transmitted
diseases.
CDC Director Dr. Julie Gerberding said the changes were being made
because thousands of infections were going undetected each year, providing
AIDS an opportunity to make a comeback after it declined sharply in the
early and mid-1990s.
About 16,000 Americans die each year from AIDS and another 40,000 become
infected with HIV. As many as 30 percent of the estimated 850,000 to 950,000
people living with the virus in the United States do not know that they are
infected.
"This is an intolerable situation," Gerberding told a news
conference in Atlanta. "Tragically (these patients) have not had the
opportunity to benefit from the potentially life-saving treatments we now
have available."
The CDC, which hopes to halve the number of new annual HIV infections by
2006, also is seeking more testing in prisons, homeless shelters and other
nonmedical settings and for programs to prevent the partners of those with
HIV becoming infected.
The agency is earmarking about $40 million toward these projects.
The new U.S. strategy follows evidence of a resurgence of HIV infections
in gay and bisexual men and in parts of the black community.
A study published by the CDC in 2002 concluded that 20 percent of
HIV-positive gay and bisexual men surveyed in Seattle reported having
unprotected sex with HIV-negative partners or others with an unknown HIV
status in 2000, nearly double the rate in 1998.
One of the key pillars of the new approach to HIV is use of a rapid HIV
test recently approved by the U.S. Food and Drug Administration. Experts say
the test could cut down on the number of late-stage HIV diagnoses.
Many people with HIV do not get tested until they become ill with the
symptoms of AIDS, and one CDC study showed that an estimated 31 percent of
this group never return to learn the results.
But the OraQuick HIV test can determine within 20 minutes if a person is
infected, compared to the two weeks laboratories often take. A second test
is needed to confirm an infection.
"It allows people to come in for the test and get the results at the
same time," said William Bruckner, a spokesman for OraSure Technologies
Inc., the Bethlehem, Pennsylvania-based company that developed the product.
"It meets a huge health need."
The product, which costs about $12, can be stored at room temperature,
requires no special equipment and can be used outside a hospital or clinic.
It is in use at about 180,000 sites throughout the United States as well as
in the Middle East and Africa, the epicenter of the AIDS epidemic.
More than 17 million Africans have died of AIDS and 25 million others
have been infected with HIV.
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Thu Apr 17, 1:11 PM ET
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To: National Desk
Contact: Jenice Robinson of the AIDS Alliance for Children, Youth & Families, 202-785-3564 x 14 or jrobinson@aids-alliance.org
WASHINGTON, April 17 /U.S. Newswire/ -- In response to a CDC announcement today rejecting counseling as a part of HIV testing, David C. Harvey, executive director of AIDS Alliance said, "receiving an HIV diagnosis is a life changing event. It can result in estrangement from family, loss of job and housing. We cannot give people - especially pregnant women - an HIV positive diagnosis without information and counseling. Removing the link between counseling and HIV testing is a mistake."
AIDS Alliance strongly believes that all pregnant women have the right to know they are being tested for HIV and to receive information about HIV, so they can make meaningful choices about testing and treatment.
"CDC's change in policy means women at high risk for HIV will be further alienated from the health care system," Harvey said. "We strongly urge states to keep HIV counseling as an integral part of testing, especially for pregnant women."
While the level of new HIV infections has remained at about 40,000 annually, reduction in mother-to-child transmission has been a remarkable public health success. By every estimate, of the 6,000 to 7,000 women living with HIV who give birth every year, the overwhelming majority know their status before delivery (71-93 percent). Existing HIV testing and counseling practices - universal counseling and voluntary testing -- have been tremendously successful in identifying HIV-positive pregnant women prior to delivery. More than 95 percent of HIV-positive women will deliver HIV-negative babies.
------ Through education, training and advocacy, AIDS Alliance addresses the needs of children, youth and families affected by HIV and AIDS.
For Lucky Few, 'Recycled' HIV Drugs Keep Hope Alive
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Mon Apr 14, 3:54 PM ET
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By E. J. Mundell
NEW YORK (Reuters Health) - Like many
Americans living with HIV, New York writer and activist Mike Barr takes
regularly scheduled, physician-sanctioned drug 'holidays,' giving his body a
temporary break from the side effects of powerful anti-retroviral medications.
What's uncommon about Barr is how he disposes of drugs he has no use for
during these treatment interruptions. Partnering with a Manhattan-based
nonprofit agency called Aid For AIDS (aidforaids.org), Barr and hundreds of
like-minded patients across the US and Canada sort, ship and distribute these
life-saving, 'recycled' drugs to HIV-positive individuals in the developing
world. "If I can take half as much therapy, and give the other half of that
therapy to someone in South America or Haiti, then for the same amount of
money two lives are being saved instead of one," he explained.
For hundreds of patients spread across Africa, the Caribbean and Central
and South America, Aid For AIDS remains a vital lifeline, providing them with
a reliable supply of medicines that would otherwise be financially out of
reach.
And since many of those enrolled in the program are AIDS educators and
activists in their local communities, their continued survival has a ripple
effect, helping prevent the spread of HIV/AIDS in these countries.
"We don't pretend to solve the problem, but we're making it a little
better for those who are making a real difference," explained
Venezuelan-born Jesus Aguais, who started Aid For AIDS in 1996 with just three
patients. That number is now 520 -- and growing.
With no advertising, the simple idea behind Aid for AIDS spread quickly via
word of mouth through the HIV patient community in the United States and
Canada, resulting in a steady supply of donated drugs.
"People for whatever reason -- they die, they change their regimen,
they never took the medicine -- they give it to us," Aguais explained in
an interview with Reuters Health.
After removing the donor's name from the label on the bottle, donated
medicines are carefully inventoried and sorted as per the requirements of
individual patients -- or "clients" as Aguais calls them -- in the
developing world.
Every foreign patient who applies for assistance from Aid For AIDS must
first undergo a careful medical assessment, because the program's small store
of medicines is best spent on those who closely adhere to the strict treatment
schedules HIV drug therapy requires.
Working via fax and email with doctors in the client's home country,
Program Director Dr. Jaime Valencia reviews application forms that outline
prospective clients' proof of HIV status, current medical history, and CD4
immune-cell blood counts.
Priority is given to AIDS activists and educators, "people who are
making a difference in their countries," Aguais stressed. In this way,
donated medicines do more than just keep individual patients alive -- they
also help prevent new infections, as individuals helped by the agency spread
the word about the dangers of HIV.
Once accepted into the program, clients must submit CD4 counts every six
months so that Valencia can chart their progress and adherence to the
medications. As often happens, specific medications can decline in
effectiveness over time, but Valencia said the agency's drug inventory is
usually flexible enough to accommodate changes in drug regimens.
"I have to talk with the client's doctor, telling him which
medications we have available, and he chooses the (new) treatment for the
patient," he explained.
Working out of a few small rooms in lower Manhattan, Aid For AIDS remains
unique.
"There are other recycling programs," Aguais said, "but none
of them work like we do. We have complete control over where these medicines
go." Because there are currently no U.S. laws allowing or prohibiting the
export of donated medicines, Aguais said it is important from a legal
standpoint "to know who the patients are." He said abuse of the
program (such as reselling donated medicines) is almost nonexistent, due to
close bonds that have formed over time between the New York office and trusted
doctors in the Americas and Africa.
Aid For AIDS also accepts non-HIV-related drugs and devices for
distribution in the developing world. Walking into a room stacked
floor-to-ceiling with donated medications, Aguais pointed to one pile in a
corner.
"Here we are preparing 13 boxes so far of medical supplies," he
said. "This is going to an indigenous area between Venezuela and Columbia
called Guajara, the Guajara tribe. We send it to a hospital that we know is
going to distribute it." Lynn Shulman, director of communications with the pioneering AIDS outreach
group Gay Men's Health Crisis, said initiatives like Aid for AIDS are
desperately needed, "because it enables people with HIV/AIDS to have
greater access to medications they need."
But money remains a problem. Although the medicines are donated, they still
require storage, sorting and shipping.
"We always struggle for money," Aguais said. "Last year with
a budget of $240,000 we sent over $5 million of HIV medicines abroad."
"We have proved, though, that things can be done -- and done well --
when you want to do it," he added. "I hope I can raise a million
dollars this year. And instead of helping 500 people, help 5,000. If we help
5,000 of the right people, this will multiply into 20,000. This is how it
happens."
Switzerland concerned over jump in HIV positive rate